终末期肾病患者左心房功能改变及与左心室功能的相关性研究

Left Atrial Function in Patients with End-stage Renal Disease and Its Correlation with Left Ventricular Function

目的应用左心房容积追踪(LAVT)技术研究终末期肾病(ESRD)患者左心房功能的变化,以及左心房功能与左心室功能的相关性。方法选取2014年12月—2016年10月于天津市第一中心医院行血液透析的ESRD患者65例为ESRD组,另选择同期经体格检查、实验室检查、心电图及超声心动图检查均无异常的志愿者58例为对照组。采用彩色超声诊断仪,配备LAVT技术软件包,测量常规超声心动图指标左心室射血分数(LVEF)、左心室短轴缩短率(FS)、左房室瓣E峰最大流速(E)、瓣环运动速度(e'),以及左心房功能指标,即经体表面积标化的左心室收缩末期左心房最大容积(LAVImax)、心电图p波对应容积(LAVIp)、左心室舒张末期左心房最小容积(LAVImin)和左心房整体排空率(LATEF)、左心房被动排空率(LAPEF)、左心房主动排空率(LAAEF)。结果ESRD组LVEF、左心室FS、E、e'低于对照组,E/e'高于对照组(P<0.05)。ESRD组LAVImax、LAVIp、LAVImin、LATEF、LAAEF高于对照组,LAPEF低于对照组(P<0.05)。ESRD组左心房功能指标LATEF与LVEF呈负相关,LAVImax、LAVIp、LAVImin、LATEF、LAAEF与E/e'呈正相关(P<0.05)。ESRD组左心房功能指标LAVImax与LAVIp、LAVImin、LATEF呈正相关,LAVImin与LATEF呈正相关,LATEF、LAPEF与LAAEF呈正相关(P<0.05)。结论 ESRD患者左心房储器功能、助力泵功能增加,管道功能减低,且储器功能在左心室舒张早期充盈中起重要作用,而助力泵功能在左心室主动充盈中具有关键作用。

Objective To study the changes of left atrial function by left atrial volume tracing( LAVT) and investigate the relationship between left atrial and ventricular functions in patients with end-stage renal disease( ESRD). Methods The enrolled 113 participants were all from Tianjin First Center Hospital, including 65 cases of ESRD who received hemodialysis( ESRD group) during December 2014 to October 2016,and 58 volunteers with normal results of physical examination,laboratory examination,electrocardiogram and echocardiography performed during the same period( control group). The left ventricular function parameters( LVEF,FS,E,e') were measured by color Doppler echocardiography and left atrial function parameters( LAVImax, LAVIp, LAVImin) were measured by LAVT software, and LATEF, LAPEF and LAAEF were calculated. Results Compared with the control group,LVEF,FS,E and e' were lower,but E/e' was increased in ESRD group( P < 0. 05). Compared with the control group,LAVImax,LAVIp,LAVImin,LATEF,LAAEF increased while LAPEF decreased in ESRD group( P < 0. 05). LATEF was negatively correlated with LVEF, and LAVImax, LAVIp, LAVImin,LATEF,LAAEF were positively correlated with E/e' in ESRD group( P < 0. 05). LAVImax was positively correlated with LAVIp,LAVImin,LATEF; LAVImin was positively correlated with LATEF; and LATEF,LAPEF were positively correlated with LAAEF in ESRD group( P < 0. 05). Conclusion Left atrial reservoir and booster pump functions are increased whereas conduit function is decreased in ESRD patients. Reservoir function plays an important role in the left ventricular early diastolic filling,while the booster pump function plays a key role in the active filling of the left ventricle.